Anxiety Disorders: Bryant RA

Bryant RA. · No affiliation provided · N Engl J Med. · Pubmed #18234757 No free full text.

This publication has no abstract.

Hobfoll SE, Watson P, Bell CC, Bryant RA, Brymer MJ, Friedman MJ, Friedman M, Gersons BP, de Jong JT, Layne CM, Maguen S, Neria Y, Norwood AE, Pynoos RS, Reissman D, Ruzek JI, Shalev AY, Solomon Z, Steinberg AM, Ursano RJ. · Summa-Kent State University, Center for the Treatment and Study of Traumatic Stress, Akron, OH 44310, USA. · Psychiatry. · Pubmed #18181708 No free full text.

Abstract: Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.

McFarlane AC, Bryant RA. · Centre of Military and Veterans Health, University of Adelaide, 122 Frome Street, Adelaide, South Australia 5000, Australia. · Occup Med (Lond). · Pubmed #17728313 No free full text.

Abstract: BACKGROUND: Post-traumatic stress disorder has had a substantial impact on employer liability for workplace psychological injury. The emergency services are an example of high-risk workforces that demand clear policies and procedures within an organization. The challenge is to minimize the injury to individuals and lessen the cost to organizations through the optimal application of preventative strategies. METHODS: This field is not well represented in standard keyword searches and Medline was examined with linked fields of practice and research. Consensus guidelines that refer to this domain were also utilized. Few conclusions can be reached from the literature which directly examined occupational settings. RESULTS: Organizations need to anticipate the possible traumatic exposures that may affect the workforce and have strategies to deal with the effects in the workplace, particularly the negative mental health outcomes in some personnel. This domain is relevant to all employers as accidents and violence are possible in most workplaces. Screening should be considered for high-risk individuals, particularly following a major traumatic event or cumulative exposure, such as in the emergency services. While psychological debriefing has no demonstrated benefit, the benefits of early intervention necessitate ready access to evidence-based treatments that have minimum barriers to care. Employers should be aware that distress may present indirectly in a similar way as conflict with management, poor performance and poor general health. CONCLUSION: The knowledge about the impact of traumatic events obliges employers to have an active strategy to anticipate and manage the aftermath of such events as well as cumulative traumatic exposures.

O'Donnell ML, Bryant RA, Creamer M, Carty J. · Australian Centre for Posttraumatic Mental Health, West Heidelberg, VIC, Australia. · Clin Psychol Rev. · Pubmed #17707563 No free full text.

Abstract: In 2005, over 2 million people in the United States of America were hospitalised following non-fatal injuries. The frequency with which severe injury occurs renders it a leading cause of posttraumatic stress disorder and other trauma-related psychopathology. In order to develop a health system model of early psychological intervention for this population, we review the literature that pertains to mental health early intervention. The relevant domains include prevalence of psychopathology following traumatic injury, the course of symptoms, screening, and early intervention strategies. On the basis of available evidence, we propose a health system model of early psychological intervention following traumatic injury. The model involves screening for vulnerability within the hospital setting, follow-up screening for persistent symptoms at one month posttrauma, and early psychological intervention for those who are experiencing clinical impairment. Recommendations are made to facilitate tailoring early intervention psychological therapies to the special needs of the injury population.

Marshall RD, Bryant RA, Amsel L, Suh EJ, Cook JM, Neria Y. · Trauma Studies and Services Center, New York State Psychiatric Institute, New York, NY 10032, USA. · Am Psychol. · Pubmed #17516775 No free full text.

Abstract: There are now replicated findings that posttraumatic stress disorder (PTSD) symptoms related to the September 11, 2001, attacks occurred in large numbers of persons who did not fit the traditional definition of exposure to a traumatic event. These data are not explained by traditional epidemiologic "bull's eye" disaster models, which assume the psychological effects are narrowly, geographically circumscribed, or by existing models of PTSD onset. In this article, the authors develop a researchable model to explain these and other terrorism-related phenomena by synthesizing research and concepts from the cognitive science, risk appraisal, traumatic stress, and anxiety disorders literatures. They propose the new term relative risk appraisal to capture the psychological function that is the missing link between the event and subjective response in these and other terrorism-related studies to date. Relative risk appraisal highlights the core notion from cognitive science that human perception is an active, multidimensional process, such that for unpredictable societal threats, proximity to the event is only one of several factors that influence behavioral responses. Addressing distortions in relative risk appraisal effectively could reduce individual and societal vulnerability to a wide range of adverse economic and ethnopolitical consequences to terrorist attacks. The authors present ways in which these concepts and related techniques can be helpful in treating persons with September 11- or terrorism-related distress or psychopathology.

Bryant RA. · School of Psychology, University of New South Wales, NSW 2052, Australia. · J Anxiety Disord. · Pubmed #17097264 No free full text.

Abstract: Peritraumatic dissociation, and other dissociative reactions, refer to alterations in awareness in the context of a traumatic experience. This review provides an overview of the current conceptualization of dissociation, critiques methodological approaches to studying dissociation, and reviews the evidence for the purported relationship between dissociative reactions and posttraumatic stress disorder. The evidence challenges the notion that a linear relationship exists between dissociation and psychiatric morbidity. Future research should abandon the global construct of dissociation, and study the specific responses that involve altered awareness under experimental conditions.

Bryant RA. · School of Psychology, University of New South Wales, NSW 2052, Australia. · Ann N Y Acad Sci. · Pubmed #16891558 No free full text.

Abstract: Fear conditioning models of posttraumatic stress disorder (PTSD) propose that noradrenergic activation at the time of trauma leads to over-consolidation of trauma memories and contributes to PTSD. This model suggests that resting heart rate (HR) in the acute phase after trauma may reflect the strength of the noradrenergic response and may represent an initial marker of those who are at risk of PTSD development. Ten prospective studies are reported that assessed the relationship of resting HR within 1 week of trauma and subsequent PTSD. Whereas 8 of the 10 studies found that elevated HR in the acute phase was associated with increased risk of subsequent PTSD, there was much variability in the HR levels and subsequent PTSD. The current data suggest multiple pathways to PTSD development that may not necessarily involve elevated HR. The data indicate that HR in the acute phase cannot be accurately used to identify people who are at risk for PTSD. The association between HR and PTSD does suggest that HR is a useful means to test fear conditioning models of trauma response.

Bryant RA. · School of Psychology, University of New South Wales, Sydney, New South Wales, Australia. · J Clin Psychiatry. · Pubmed #16602816 No free full text.

Abstract: In the aftermath of the Asian tsunami, there is potentially a large, traumatized population in need of psychosocial support, but determining which individuals require psychological intervention and knowing how and when to treat them may be the key to positive long-term outcomes. The early identification of people at high risk of developing subsequent psychiatric disorders from among those experiencing a transient stress reaction following trauma is often the initial step in the recovery process. Clinical instruments for screening and/or predicting those most at risk are available and require validating for cultural and linguistic sensitivity. Timely treatment is essential, since inappropriately targeted therapy can compromise recovery and may even exacerbate posttraumatic stress symptoms, particularly if treatment is initiated before grief reactions have subsided. Finally, appropriate treatment interventions, which incorporate cognitive-behavioral therapy and prolonged exposure, offer the best current therapeutic options for the treatment of posttraumatic stress disorder and associated comorbid conditions such as anxiety, depression, and grief. However, since most of the supportive data for the psychosocial consequences of trauma were obtained from small-scale studies of discrete trauma events in Western countries, it may not be possible to extrapolate these findings to a large-scale natural disaster in Asia, such as the Asian tsunami. More data are required to assist in the development of strategies for the effective management of the psychological consequences of trauma worldwide, with emphasis on creating mental health strategies that are culturally sensitive and valid for various trauma events and disaster scenarios.

Bryant RA. · University of New South Wales, Sydney, Australia. · J Trauma Dissociation. · Pubmed #16150665 No free full text.

Abstract: There is much interest in identifying people shortly after trauma exposure who will subsequently develop posttraumatic stress disorder (PTSD). This review outlines recent developments in early identification of trauma-exposed people who are at high risk for PTSD development, including the rationale, evidence, and limitations of the acute stress diagnosis as a predictor of chronic PTSD. The potential role of acute dissociative responses mediating development of PTSD is also reviewed. The available evidence suggests that whereas acute dissociation is an important factor in the acute stress response, many people develop PTSD in the absence of dissociative symptoms. The evidence suggests that dissociation needs to be considered in the context of other factors in the aftermath of trauma if optimal identification of high-risk individuals is to be achieved.

Bryant RA. · School of Psychology, University of New South Wales, Sydney, Australia. · CNS Spectr. · Pubmed #15685122 links to  free full text

Abstract: What are the conceptual and empirical bases for current interventions for acute stress reactions following trauma exposure? This review compares the two major alternatives to managing acute stress reactions, outlines their conceptual bases and critiques the evidence for their efficacy in preventing subsequent stress disorders. The review integrates current evidence for cognitive behavior therapy with recent neuroscience findings that fear reduction learning can be enhanced by modulating glutamatergic systems. D-cycloserine provides exciting opportunities to enhance the effects of cognitive-behavioral therapy, and points to closer understanding of the biological mechanisms that underpin clinical gains achieved by psychological therapies.

Bryant RA. · School of Psychology, University of New South Wales, Sydney, Australia. · CNS Spectr. · Pubmed #15079140 No free full text.

Abstract: What biological responses characterize those acute trauma reactions that develop into chronic psychiatric disorder? The need to understand the genesis of posttraumatic psychological disorders has resulted in much attention on biological reactions in the initial aftermath of trauma exposure. This review outlines the prevailing biological models of acute stress reaction and critiques the available evidence concerning biological responses to trauma that are associated with subsequent psychological disorder. The roles of peritraumatic dissociation and vulnerability factors for acute stress reaction are also reviewed. The major challenges for research on psychobiological responses to trauma are highlighted.

O'Donnell ML, Creamer M, Bryant RA, Schnyder U, Shalev A. · Department of Psychology, University of Melbourne, Australia. · Clin Psychol Rev. · Pubmed #12788111 No free full text.

Abstract: Although there has been a marked increase in research on psychological disorders following physical injury in recent years, there are many discrepancies between the reported findings. This paper reviews the prevalence outcomes of recent studies of the mental health sequelae of physical injury with a focus on posttraumatic stress disorder (PTSD), acute stress disorder (ASD), and depression. The review critically outlines some of the methodological factors that may have contributed to these discrepancies. The phenomenological overlap between organic and psychogenic symptoms, the use of narcotic analgesia, the role of brain injury, the timing and content of assessments, and litigation are discussed in terms of their potential to confound findings with this population. Recommendations are proposed to clarify methodological approaches in this area. It is suggested that a clearer understanding of the psychological effects of physical injury will require the widespread adoption of more rigorous, standardized and transparent methodological procedures.

Harvey AG, Bryant RA, Tarrier N. · Department of Experimental Psychology, University of Oxford, Oxford, UK. · Clin Psychol Rev. · Pubmed #12729682 No free full text.

Abstract: Following considerable empirical scrutiny, cognitive behaviour therapy (CBT) has proven to be a safe and effective treatment for posttraumatic stress disorder (PTSD). This article overviews the general principles of treatment and describes the components that comprise CBT for PTSD. We then move on to review the efficacy of CBT for the treatment of PTSD caused by various traumas, including assault, road traffic accident (RTA), combat, and terrorism. Recent advances in early intervention and in the treatment of disorders that are comorbid with PTSD are reviewed. Finally, future directions are discussed. In particular, it is proposed that randomised controlled trials (RCT) of CBT for PTSD must be conducted with enhanced methodological rigour and public health relevance.

Bryant RA. · University of New South Wales, Sydney, Australia. · Biol Psychiatry. · Pubmed #12725971 No free full text.

Abstract: The benefits of providing early intervention for people recently exposed to trauma have highlighted the need to develop means to identify people who will develop chronic posttraumatic stress disorder (PTSD). This review provides an overview of prospective studies that have indexed the acute reactions to trauma that are predictive of chronic posttraumatic stress disorder. Ten studies of the predictive power of the acute stress disorder diagnosis indicate that this diagnosis does not have adequate predictive power. There is no convergence across studies on any constellation of acute symptoms that predict posttraumatic stress disorder. A review of biological and cognitive mechanisms occurring in the acute posttraumatic phase suggests that these factors may provide more accurate means of predicting chronic posttraumatic stress disorder. Recommendations for future research to facilitate identification of key markers of acutely traumatized people who will develop posttraumatic stress disorder are discussed.

Harvey AG, Bryant RA. · Department of Experimental Psychology, University of Oxford, United Kingdom. · Psychol Bull. · Pubmed #12405136 No free full text.

Abstract: The diagnosis of acute stress disorder (ASD) was introduced to describe initial trauma reactions that predict chronic posttraumatic stress disorder (PTSD). This review outlines and critiques the rationales underpinning the ASD diagnosis and highlights conceptual and empirical problems inherent in this diagnosis. The authors conclude that there is little justification for the ASD diagnosis in its present form. The evidence for and against the current emphasis on peritraumatic dissociation is discussed, and the range of biological and cognitive mechanisms that potentially mediate acute trauma response are reviewed. The available evidence indicates that alternative means of conceptualizing acute trauma reactions and identifying acutely traumatized people who are at risk of developing PTSD need to be considered.

Kangas M, Henry JL, Bryant RA. · School of Psychology, University of New South Wales, Sydney, New South Wales 2052, Australia. · Clin Psychol Rev. · Pubmed #12094509 No free full text.

Abstract: Life-threatening illness has recently been recognized as a stressor that can precipitate posttraumatic stress disorder (PTSD). This development has raised questions over the extent to which the PTSD diagnosis is applicable to the psychological reaction to being diagnosed with cancer. This paper identifies the core conceptual issues pertaining to cancer-related PTSD, critically reviews the empirical literature on PTSD following cancer, and considers the possible mechanisms and course of PTSD following a diagnosis of cancer. Specific issues that need to be considered in the assessment and treatment of cancer-related PTSD are reviewed. This review highlights that there is a need for stronger empirical base to guide clinical management of PTSD in cancer patients.

Bryant RA. · University of New South Wales, Sydney, NSW, Australia. · J Clin Exp Neuropsychol. · Pubmed #11910539 No free full text.

Abstract: Posttraumatic stress disorder (PTSD) is an anxiety condition that often arises following a traumatic experience. It has commonly been argued that impaired consciousness associated with mild brain injury (MBI) precludes encoding of the traumatic experience, and this prevents PTSD development. This review considers the available evidence on PTSD following MBI and indicates the distinctive nature of PTSD after MBI. The review then discusses the possible mechanisms that may mediate PTSD in this population. The interaction of PTSD and postconcussive symptoms is discussed within a cognitive model that emphasizes the role of catastrophic interpretations of postconcussive symptoms. Finally, the implications of PTSD after MBI for assessment and treatment are reviewed.

Salmon K, Bryant RA. · School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia. · Clin Psychol Rev. · Pubmed #11806018 No free full text.

Abstract: Despite the prevalence of childhood trauma, there are currently no developmentally oriented cognitive theories of posttraumatic stress disorder (PTSD). This paper outlines the definitional issues of PTSD in children, reviews the incidence of PTSD in children, and compares PTSD profiles in children and adults. We propose that a cognitive theory of childhood PTSD needs to accommodate developmental factors, including knowledge, language development, memory, emotion regulation, and social cognition, in addition to contextual factors such as family interactions. Implications of these developmental factors for assessment and treatment of traumatized children are discussed.

Bryant RA. · School of Psychology, University of New South Wales, Sydney, Australia. · Clin Psychol Rev. · Pubmed #11497213 No free full text.

Abstract: The possibility that posttraumatic stress disorder (PTSD) can develop following traumatic brain injury (TBI) has been the subject of considerable debate. The traditional view has held that impaired consciousness that occurs with TBI precludes encoding of the traumatic experience, and this prevents subsequent reexperiencing symptoms. This paper critically reviews available, empirical studies on PTSD in TBI populations and suggests that these two conditions can co-exist. The various mechanisms that may mediate PTSD following TBI are discussed, and special attention is given to issues that recognize the distinctive features of PTSD following TBI. These processes include implicit processing, biologically mediated fear conditioning, and reconstruction of trauma memories. Finally implications for assessment, treatment, and forensic investigation of PTSD in TBI populations are, addressed. This review concludes that TBI populations provide a useful means by which the role of traumatic memories (and impaired memories) in posttraumatic adjustment can be studied.

Williams LM, Kemp AH, Felmingham K, Barton M, Olivieri G, Peduto A, Gordon E, Bryant RA. · Brain Dynamics Centre, Westmead Hospital, Westmead, NSW 2145, Australia. · Neuroimage. · Pubmed #16216534 No free full text.

Abstract: Effective fear processing relies on the amygdala and medial prefrontal cortex (MPFC). Post-trauma reactions provide a compelling model for examining how the heightened experience of fear impacts these systems. Post-traumatic stress disorder (PTSD) has been associated with excessive amygdala and a lack of MPFC activity in response to nonconscious facial signals of fear, but responses to consciously processed facial fear stimuli have not been examined. We used functional MRI to elucidate the effect of trauma reactions on amygdala-MPFC function during an overt fear perception task. Subjects with PTSD (n = 13) and matched non-traumatized healthy subjects (n = 13) viewed 15 blocks of eight fearful face stimuli alternating pseudorandomly with 15 blocks of neutral faces (stimulus duration 500 ms; ISI 767 ms). We used random effects analyses in SPM2 to examine within- and between-group differences in the MPFC and amygdala search regions of interest. Time series data were used to examine amygdala-MPFC associations and changes across the first (Early) versus second (Late) phases of the experiment. Relative to non-traumatized subjects, PTSD subjects showed a marked bilateral reduction in MPFC activity (in particular, right anterior cingulate cortex, ACC), which showed a different Early-Late pattern to non-traumatized subjects and was more pronounced with greater trauma impact and symptomatology. PTSD subjects also showed a small but significant enhancement in left amygdala activity, most apparent during the Late phase, but reduction in Early right amygdala response. Over the time course, trauma was related to a distinct pattern of ACC and amygdala connections. The findings suggest that major life trauma may disrupt the normal pattern of medial prefrontal and amygdala regulation.

Bryant RA, Felmingham KL, Kemp AH, Barton M, Peduto AS, Rennie C, Gordon E, Williams LM. · School of Psychology, University of New South Wales, Sydney, Australia. · Biol Psychiatry. · Pubmed #16038681 No free full text.

Abstract: BACKGROUND: Neuroimaging studies report reduced medial prefrontal cortical (particularly anterior cingulate) but enhanced amygdala response to fear signals in posttraumatic Stress Disorder (PTSD). We investigated whether anterior cingulate-amygdala dysregulation in PTSD would generalize to salient, but nonthreat related signals. METHODS: Individuals with PTSD (n = 14) and age and sex-matched nontraumatized controls (n = 14) completed an auditory oddball paradigm adapted to functional magnetic resonance imaging at a 1.5-T field strength. RESULTS: Controls displayed bilateral activation in ventral anterior cingulate and amygdala networks, and PTSD subjects showed bilateral dorsal anterior cingulate and amygdala activation to targets relative to nontargets. Compared to controls, PTSD subjects showed enhanced responses to targets in the dorsal and rostral anterior cingulate, and left amygdala. Whole-brain analyses confirmed the expected pattern of distributed prefrontal-parietal responses to targets in the oddball task. Greater activity in posterior parietal somatosensory regions was observed in PTSD. CONCLUSIONS: Our findings of enhanced anterior cingulate responses in PTSD contrast with reports of reduced activity for threat stimuli, suggesting that the latter may be specific to processing of threat-related content. Activation in rostral and dorsal anterior cingulate, left amygdala and posterior parietal networks in response to salient, nonthreatening stimuli may reflect generalized hypervigilance.

McFarlane A, Clark CR, Bryant RA, Williams LM, Niaura R, Paul RH, Hitsman BL, Stroud L, Alexander DM, Gordon E. · Department of Psychiatry, The University of Adelaide, Queen Elizabeth Hospital, Woodville, SA 5011, Australia. · J Integr Neurosci. · Pubmed #16035139 No free full text.

Abstract: Early Life Stress (ELS) has been associated with a range of adverse outcomes in adults, including abnormalities in electrical brain activity [1], personality dimensions [40], increased vulnerability to substance abuse and depression [14]. The present study seeks to quantify these proposed effects in a large sample of non-clinical subjects. Data for the study was obtained from The Brain Resource International Database (six laboratories: two in USA, two in Europe, two in Australia). This study analyzed scalp electrophysiological data (EEG eyes open, closed and target auditory oddball data) and personality (NEO-FFI), history of addictive substance use and ELS) data that was acquired from 740 healthy volunteers. The ELS measures were collected via a self-report measure and covered a broad range of events from childhood sexual and physical abuse, to first-hand experience of traumatizing accidents and sustained domestic conflict [41]. Analysis of covariance, controlling for age and gender, compared EEG data from subjects exposed to ELS with those who were unexposed. ELS was associated with significantly decreased power across the EEG spectrum. The between group differences were strongest in the eyes closed paradigm, where subjects who experienced ELS showed significantly reduced beta (F1,405=12.37, p=.000), theta (F1,405=20.48, p=.000), alpha (F1,405=9.65, p=.002) and delta power (F1,450=36.22, p=.000). ELS exposed subjects also showed a significantly higher alpha peak frequency (F1,405=6.39, p=.012) in the eyes closed paradigm. Analysis of covariance on ERP components revealed that subjects who experienced ELS had significantly decreased N2 amplitude (F1,405=7.73, p=.006). Analyses of variance conducted on measures of personality revealed that subjects who experienced ELS had significantly higher levels of neuroticism (F1,264=13.39, p=.000) and openness (F1,264=17.11, p=.000), but lower levels of conscientiousness, than controls (F1,264=4.08, p=.044). The number of ELS events experienced was shown to be a significant predictor of scores on the DASS questionnaire [27], which rates subjects on symptoms of depression (F3,688=16.44, p=.000, R2=.07), anxiety (F3,688=14.32, p=.000, R2=.06) and stress (F3,688=20.02, p=.000, R2=.08). Each additional early life stressor was associated with an increase in these scores independent of age, gender and the type of stressor. Furthermore, the number of ELS experiences among smokers was also found to be a positive predictor of the nicotine dependency score (Faegstrom Test For Nicotine Dependence, [19]) (F3,104=10.99, p=.000, R2=.24), independent of age, gender and type of stressor. In conclusion, we highlight the impact of a history of ELS showed significant effects on brain function (EEG and ERP activity), personality dimensions and nicotine dependence.

Bryant RA, Moulds ML, Guthrie RM, Nixon RD. · School of Psychology, University of New South Wales, Sydney, NSW, Australia. · J Consult Clin Psychol. · Pubmed #15796641 No free full text.

Abstract: This research represents the first controlled treatment study of hypnosis and cognitive- behavioral therapy (CBT) of acute stress disorder (ASD). Civilian trauma survivors (N=87) who met criteria for ASD were randomly allocated to 6 sessions of CBT, CBT combined with hypnosis (CBT-hypnosis), or supportive counseling (SC). CBT comprised exposure, cognitive restructuring, and anxiety management. CBT-hypnosis comprised the CBT components with each imaginal exposure preceded by a hypnotic induction and suggestions to engage fully in the exposure. In terms of treatment completers (n=69), fewer participants in the CBT and CBT-hypnosis groups met criteria for posttraumatic stress disorder at posttreatment and 6-month follow-up than those in the SC group. CBT-hypnosis resulted in greater reduction in reexperiencing symptoms at posttreatment than CBT. These findings suggest that hypnosis may have use in facilitating the treatment effects of CBT for posttraumatic stress.

Bryant RA, Moulds ML, Guthrie RM, Dang ST, Nixon RD. · School of Psychology, University of New South Wales, Sydney, Australia. · J Consult Clin Psychol. · Pubmed #12924676 No free full text.

Abstract: This study investigated the extent to which providing cognitive restructuring (CR) with prolonged imaginal exposure (IE) would lead to greater symptom reduction than providing IE alone for participants with posttraumatic stress disorder (PTSD). Fifty-eight civilian survivors of trauma with PTSD were randomly allocated to IE/CR, IE, or supportive counseling (SC). Treatment involved 8 individual weekly sessions with considerable homework. Independent assessments were conducted pretreatment, posttreatment, and at 6-month follow-up. IE/CR and IE resulted in reduced PTSD and depression compared with SC at posttreatment and follow-up. Further, IE/CR participants had greater reductions in PTSD and maladaptive cognitive styles than IE participants at follow-up. These findings suggest that providing CR in combination with IE may enhance treatment gains.

Felmingham KL, Bryant RA, Gordon E. · School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia. · Neuroreport. · Pubmed #12692482 No free full text.

Abstract: This study examined evoked response potentials (ERPs) to angry and neutral faces in 15 individuals with post-traumatic stress disorder (PTSD) and 15 age and sex-matched controls over temporal (T5,T6) and occipital (O1,O2) regions. Twenty faces with an angry expression were alternated with 20 faces with a neutral emotional expression. There were significantly larger early negative (N110) and late negative (N650) ERP components in controls to the angry compared to the neutral faces. The PTSD group did not display ERP differences between angry and neutral faces, and the amplitude of their negative waveforms were reduced relative to controls. These findings may reflect adaptive, rapid responding to potential threat in the controls, and a reduced capacity to discriminate between non-threat and generalized threat stimuli in PTSD.